“I think a long, deep recession will accelerate” the adoption of these plans, said Tom Beauregard, who leads product development for UnitedHealthcare, which launched its Vital Measures plan last year. “This is the next frontier for how we manage costs because you’re not going to do it through increased cost sharing.”

Adopting these plans will mean employers will have to embrace a notion that consumers, according to internal research by UnitedHealth, have been more willing to accept: that people who lead unhealthy lifestyles should pay more for their health care.

Employees would still have access to care and catastrophic coverage. A deductible, however, would decrease if a person improved or maintained good health.

Until now, most health plans and employers have rewarded employees for participating in wellness programs rather than achieving good health in four areas: weight, not smoking, cholesterol and blood pressure.

Employers are increasingly recognizing the connection between a person’s lifestyle and their health care costs. More are willing to offer monetary incentives for employees to participate in wellness programs. Few, however, have tied incentives to employees’ ability to be healthier.

A typical program is designed to work with a high deductible. If a deductible is $1,500, for example, an employer could offer four opportunities for an employee to earn a total of $1,000 off his or her deductible.

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